Understanding Donor Insemination

Getting Pregnant With a Sperm Donor

Donor insemination is a fertility treatment that involves using a sperm donor to conceive. Insemination typically refers to intrauterine insemination (IUI) with a donor or an intended parent’s sperm, but donor insemination can also be used with intra-vaginal insemination or as part of an IVF cycle as well.

An estimated 172,000 insemination procedures are completed every year, with half of them being donor inseminations. However, the actual insemination rate is likely much higher. Because donor insemination in the United States is not tracked, getting the exact number of procedures and resulting births is currently impossible.

Donor insemination may be the pathway you choose to build your family. Here’s what you need to know.

Who Needs Donor Insemination to Get Pregnant?

An individual or couple may consider donor insemination for any number of reasons.

Male Partner With Severe Male Infertility

Infertile couples facing severe male infertilityazoospermia or extremely low sperm count—may consider donor sperm.

For some of these couples, IVF with ICSI and TESE or TESA may be another option they consider before moving onto donor sperm.

TESE stands for testicular sperm extraction, and TESA stands for testicular sperm aspiration. TESE involves testicular biopsy, while TESA involves aspirating sperm cells from the testicles. These sperm cells mature in the lab. Next, they can be used to inseminate an egg via IVF-ICSI, where a sperm cell is directly injected into an oocyte.

However, this isn’t an option for all couples. For some men, even TESE and TESA can’t retrieve viable sperm cells for IVF. Another issue with IVF-ICSI with TESE/TESA is it can be prohibitively expensive. Donor insemination isn’t cheap, but it’s significantly less costly than IVF-ICSI with TESE/TESA.

Another reason why a couple may choose donor sperm over pursuing IVF-ICSI with TESE/TESA is the increased risk of passing on male infertility to a male child. Some intended parents are okay with this risk, while others are not.

The Male Partner Has an STD That Can’t be Treated

The vast majority of sexually transmitted infections can be treated. However, there is an increasing number of STIs that are antibiotic resistant. Sometimes IVF can be used to reduce the risk of passing on the disease to the female partner, but not every couple wants to go that route.

For these couples, donor insemination might be a possible road to parenthood.

If a male partner is HIV positive and the female partner is HIV negative, there may still be a possibility of the couple having a genetic baby together without passing on HIV to the female partner. This involves the use of anti-viral drugs and sperm washing. Talk to your doctor about your personal situation.

Non-correctable Problems With Ejaculation

As discussed earlier, sometimes treatments like TESE or TESA can be used along with IVF-ICSI to enable a couple to have a genetic child together. However, not all couples are able or want to pursue this option. They may want to look at donor insemination as a pathway to parenthood.

Genetic or Hereditary Disease Concerns on Male Partner’s Side

IVF with PGD—a method of screening for genetic diseases—can be used in some cases. However, some couples would prefer to use a sperm donor.

In rare cases, couples that are Rh incompatible may consider donor sperm. This can usually be resolved with treatment, but if the female partner can’t have the Rhogam shot, due to an allergy, for example, a sperm donor may be another option.

Single women

Women who want to have a baby but don’t have a partner may consider getting donor sperm.

Lesbian Couples

Lesbian couples frequently seek out a sperm donor to have a child.

What Happens Before the Donor Insemination Process

The steps before the actual donor insemination will vary depending on your situation. For example, have you been trying to have a baby for a while, and this is your next step in fertility treatment? Or, are you just starting to consider building a family and donor insemination is your chosen path?

With this caveat in mind, here’s what you might expect before your donor insemination cycle.

Finding a Physician or Fertility Clinic

First, you’ll want to find a primary care provider or a fertility clinic who can oversee your donor insemination process and cycle. This will typically be a fertility clinic, but some gynecologists and midwives offer guidance and support during donor insemination.

Midwives, in particular, may be able to assist with at-home insemination, but there are potential legal risks to doing at-home insemination, even with a midwife supervising. (More on this below.)

Whenever you’re looking for a doctor or clinic, take into consideration not only their success rates but also their attitudes. This is especially important for single women and lesbian couples looking to have a baby. You want to be in an environment that welcomes and accepts your lifestyle.

Basic Fertility Testing

Even if you have no known fertility problems, you will want to have at least basic fertility testing before you try donor insemination.

Why have basic fertility testing? The primary advantage is to avoid wasting time and money on donor insemination cycles that are unlikely to succeed.

For example, you may have blocked fallopian tubes from an undiagnosed infection. You can’t get pregnant with donor insemination if your tubes are blocked. Another example, perhaps you have an undiagnosed ovulation problem. You might benefit from adding fertility drugs to your insemination cycles, but you wouldn’t know that if you didn’t do testing first.

Basic fertility testing involves...

  • Basic gynecological screenings like a pap smear and sexually transmitted infection testing
  • Hormonal blood work
  • A specialized X-ray known as an HSG
  • A pelvic ultrasound, specifically an antral follicle count (especially if you’re age 35 or older) 

Having fertility testing doesn’t guarantee that your insemination cycle will be successful, but good results at least indicate the odds are in your favor. 

Psychological Counseling

Your physician may or may not require counseling before proceeding with a donor insemination cycle. This depends on your situation and how you came to this family building decision.

Whether or not your health care provider recommends counseling, you should seriously consider seeking it out yourself before proceeding.

Topics you may discuss with a counselor include...

  • Informed consent on the possible psychological risks and benefits of donor insemination
  • Processing any feelings of shame regarding donor conception
  • Grieving the loss of one partner not having a genetic connection to the child (applies to couples with several male infertility and lesbian couples)
  • Processing the emotions that come with single motherhood-by-choice
  • Deciding who will carry the pregnancy (for lesbian couples)
  • Understanding the benefits and risks of using a known sperm donor
  • Understanding the benefits and risks of choosing an anonymous, semi-open, or open sperm donor
  • Discussing how you’ll decide which sperm donor to use
  • Considering how and when you’ll tell your child about their donor conception roots

(Maybe) Legal Counseling

Legal counseling may be recommended or required, depending on your situation. For example, if you’re a lesbian couple, the partner who doesn’t carry the pregnancy may want to pursue legal adoption of the baby when he or she is born. This should be discussed and considered before pregnancy even starts.

Another situation when legal counseling is strongly recommended is if you’re using a known donor. There are many legal risks to this path, and you will want to seek out legal advice from a lawyer familiar with family reproductive law.

Finding a Sperm Donor

You can find a donor...

  • Through your fertility clinic
  • Through a sperm bank
  • Through your personal connections

When looking at sperm donors found through a clinic or sperm bank, you’ll also hear terms like “semi-open” and “anonymous” donor arrangements. This refers to the ability to have contact between your future donor-conceived child and the donor.

The general advice these days favors semi-open arrangements because it allows at least one contact between the donor-conceived child and the sperm donor. Completely anonymous donor arrangements are becoming less common, and are in fact illegal in some countries.

If you decide to use someone you know—also known as a “known donor”—be aware that there are many legal and psychological intricacies involved.

There have been cases where known sperm donors later decided to sue and attempt to get parental rights, and there have been cases when women who have used a known sperm donor attempted to sue the donor for child support payments. These things have occurred even with contracts being signed before donor insemination took place.

Be sure to consult with both a psychologist and a lawyer before you seriously consider using someone you know as a sperm donor.

Choosing a Sperm Donor

The process of choosing a sperm donor is a personal one. There’s really no right or wrong way to decide, but there are some basic things to know before you start your search.

Sperm bank databases carry various amounts of information. You’ll likely find at least one picture (usually of the donor when they were a baby or young child), and some personal details like their profession and likes and dislikes. Some donor databases will give you personality and IQ testing results.

Something to keep in mind is that your donor-conceived child isn’t destined to have the exact likes and dislikes as their donor. Think about how much you have in common with your genetic mother and father, assuming you know them. You may have some things in common, but in other ways, you are likely very different.

All that said, some factors you may consider when choosing a donor include…

  • What they look like—you might want a donor with the same hair and eye color as your partner, for example
  • Their blood type—this is especially important if the woman who will be carrying the baby is Rh negative
  • Their medical and psychological history
  • Their “personality”—which you may have to guess at based on their answers to questions found in the database

The Donor Insemination Cycle

What your donor insemination will look like depends on whether you’re going to have an…

  • Intra-cervical (ICI) or intra-vaginal insemination (IVI)
  • Intrauterine insemination (IUI)
  • IVF with donor sperm

There are advantages and disadvantages to every option. Be sure to discuss your options with your health care provider.

Generally speaking, IUI is the most common method used because the success rate is slightly higher than intra-vaginal or intra-cervical insemination. IVF with donor sperm is only chosen if there are fertility challenges with the woman carrying the baby.

You may have a natural cycle or a cycle with fertility drugs. A natural cycle just means that you won’t be taking any fertility drugs to stimulate or boost ovulation. You only need fertility drugs with insemination if there are ovulation concerns in the woman who will carry the pregnancy.

Can You Do a Donor Insemination At-Home?

Yes, you can, but there are risks to at-home insemination. From a legal and medical standpoint, you should seriously consider doing the insemination at a fertility clinic or doctor’s office.

Why might someone want to do the donor insemination at-home?

  • Intimacy—insemination in a fertility clinic is not romantic
  • Cost—at-home insemination is going to cost less than doing so at a medical office
  • Discrimination—single women or lesbian couples living in rural areas may have difficulty finding a clinic willing to work with them

Some donor banks will send donor sperm to your home, along with instructions on how to inseminate yourself. Inseminations at home are always vaginal. Never attempt intrauterine insemination (IUI) yourself. Always talk to a medical professional on how to do this process safely.

If you’re planning on using a known donor (someone you know personally), you absolutely should not try at-home insemination.

The law in many locations states that donor insemination done outside of a medical facility with a known person is not legally considered donor insemination. The sperm donor would be considered the child’s legal father, and he would have the legal rights and obligations of any biological father, regardless of any contracts signed saying otherwise.

Will You Get Pregnant? Success Rates for Donor Insemination

Your odds of success depends on several factors, including...

  • Type of insemination procedure (IUI is more successful than ICI or vaginal insemination)
  • Age of the woman being inseminated
  • Any underlying or present female fertility problems
  • Whether or not fertility drugs were used with the cycle
  • Healthy lifestyle habits of the female partner
  • The health of the male donor (more relevant when using a known donor, since all sperm donors are carefully screened.)

In a study of 402 women having IUI with donor sperm, researchers found that the pregnancy rate per cycle was 17.2 percent. This rate was calculated over 1,264 cycles in total. (In other words, most women had multiple insemination cycles before achieving pregnancy success.)

There is a misconception that you are likely to get pregnant in the first cycle you try. This isn’t true. While it’s possible, it’s not likely.

The recommendation is to try three to six cycles of IUI before considering other higher-tech methods of conception.

How Much Does Donor Insemination Cost?

For the price of donor sperm, you can expect to pay anywhere from $700 to $1,200, especially after you consider shipping. This would be for one vial of donor sperm, good for one cycle or attempt.

Known donors don’t receive financial compensation (typically) for donating. However, they will still need to go through medical screening, and the sperm will need to be processed and stored. This will cost at least a few hundred dollars.

Considering that you may need to try a few cycles to achieve pregnancy success, you may want to have the donor bank send to your fertility clinic a few vials at once to save a little money. Shipping donor sperm can be very expensive.

Another reason you may want to purchase multiple vials of the same donor sperm is that you hope to have more than one child and hope to use the same donor sperm (if possible) for each conception. You’ll also need to consider storage fees charged by your clinic, which can be a few hundred to several hundred dollars per year.

On top of the cost of the donor sperm itself, you will also need to pay for consultation with your doctor, possible legal fees (if using a known donor), payment to meet with a counselor (especially if this is in resolution to male infertility), any fertility drugs, any costs for monitoring the cycle (ultrasounds, blood work), and the insemination procedure itself.

When all is said and done, you may expect to pay anywhere from $2,000 to $4,000. Subsequent cycles will add up to additional fees. However, some costs may not repeat. (For example, if you shipped the vials in bulk already to your clinic, or you’re finished consulting with a therapist or lawyer, you won’t be paying for those services again.)

Is Donor Insemination Safe? What Are the Risks?

Donor insemination via a fertility clinic is generally safe. Assuming no fertility drugs are being used (which introduces an entirely different set of potential risks), the primary medical risks to donor insemination are…

  • Risk of infection
  • Risk of the family medical history shared by the donor being incorrect

Sperm banks and fertility clinics do their very best to screen donors and verify information shared by donors. However, there have been cases where donors have left out vital family history information. (For example, a history of mental disease in the family.)

Regarding infection, there have been very few studies on donor insemination and risk. However, one study reported that over an 18-year period, 47 women reported infection after donor insemination. The researches estimated from this that the odds of infection from donor insemination are 1 in 10,000.

Alternative Options to Donor Insemination

Your alternative options to donor insemination depend on why you’re considering using a sperm donor.

With that said, some possible alternatives include...

  • IVF with an embryo donor
  • IVF with ICSI and TESE/TESA (testicular sperm extraction, if that’s a possibility in your particular case)
  • Adoption
  • Foster parenting
  • Co-parenting (which can include insemination, to some degree, except with co-parenting, the known donor would be agreeing to also play a parenting role in the child’s life)
  • Living a child-free life

A Word From Verywell

Donor insemination is a path to parenthood that many individuals take, for a variety of reasons. Coming to this decision, choosing your donor, and proceeding with the insemination cycles can be stressful. That said, the process can also bring joy, excitement, and hope. Don’t feel like you need to go through this process alone. Talk to your health care provider and a professional counselor who is familiar with donor conception so you can feel supported and make informed decisions. 

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